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Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1759-

Ophthalmoplegic Migraine: A Misnomer of Recurrent Painful Ophthalmoplegic Neuropathy

Hung Youl Seok, Mi-Yeon Eun 
 Departments of Neurology, Dongsan Medical Center, Keimyung University, School of Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea

Correspondence Address:
Mi-Yeon Eun
Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Buk-gu, Daegu 41404
Republic of Korea




How to cite this article:
Seok HY, Eun MY. Ophthalmoplegic Migraine: A Misnomer of Recurrent Painful Ophthalmoplegic Neuropathy.Neurol India 2022;70:1759-1759


How to cite this URL:
Seok HY, Eun MY. Ophthalmoplegic Migraine: A Misnomer of Recurrent Painful Ophthalmoplegic Neuropathy. Neurol India [serial online] 2022 [cited 2022 Dec 1 ];70:1759-1759
Available from: https://www.neurologyindia.com/text.asp?2022/70/4/1759/355148


Full Text



A 48-year-old woman presented with migraine-like headache and diplopia. The headache was severe, throbbing, and localized in the left temporal area, and it was associated with nausea and photophobia. Her headache disappeared within a day. She had a history of migraine without aura for at least 7 years, occurring about once every 2 months. The headache during the current episode was similar to her habitual headache. The diplopia began several hours after the onset of headache and completely recovered after 6 days. She reported having had a similar episode of diplopia with migraine-like headache 7 years ago. Brain magnetic resonance imaging (MRI) showed thickening and enhancement of the cisternal portion of the left oculomotor nerve [Figure 1]. There were no abnormalities in other structures, including the orbital, parasellar, and posterior fossa region. Cerebrospinal fluid (CSF) analysis revealed a white blood cell count of 0 cells/mL, a slightly elevated CSF protein level of 62.3 mg/dL (normal range: <45 mg/dL), and a normal CSF/serum glucose ratio, suggesting inflammatory reaction. We diagnosed her with ophthalmoplegic migraine presenting with oculomotor nerve paresis. As there was evidence showing an inflammatory reaction in the oculomotor nerve, she was given high-dose intravenous steroid treatment for 5 days. During a 2-year follow-up, she had no recurrence.{Figure 1}

In the third edition of the International Classification of Headache Disorders (ICHD-3), ophthalmoplegic migraine has been renamed recurrent painful ophthalmoplegic neuropathy because of its response to steroids and the appearance of gadolinium enhancement or nerve thickening on MRI.[1] However, there is still debate as to whether ophthalmoplegic migraine is a migraine phenomenon or a different sort of condition entirely.[2],[3],[4] In our case, the patient showed increased CSF protein during the episode. This finding provides further support for the ICHD-3 that ophthalmoplegic migraine is a misnomer because it is not a migraine variant but rather a recurrent inflammatory cranial neuropathy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38:1-211.
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3McMillan HJ, Keene DL, Jacob P, Humphreys P. Ophthalmoplegic migraine: Inflammatory neuropathy with secondary migraine? Can J Neurol Sci 2007;34:349-55.
4Romano LM, Besocke AG. Teaching video neuroimages: Recurrent oculomotor neuropathy with isolated ptosis vs ophthalmoplegic migraine. Neurology 2009;72:e44.